Military Medical Readiness and Patient Experience with Access to Care.

OBJECTIVES: Introduction: Medical readiness is an integral component of total readiness and a prime indicator of an individual's overall fitness to deploy. Promoting medical readiness is the prime directive for military medical departments; however, there are few studies evaluating specific factors of care delivery that will improve medical readiness. In this study, we evaluated one of the common patient perceptions that access to routine and specialty care will have a positive effect on military medical readiness. Surprisingly, there appeared to be a reverse relationship between a patient's perception of access to care and the correlation to their medical readiness. MATERIALS AND METHODS: This study uses the Joint Outpatient Experience Survey data of Army active duty soldiers (December 2017 through May 2018) to investigate the relationship between access to care and medical readiness. Medical readiness scores were examined a month before and a month after a medical encounter. Medical Readiness Categories (MRC) were collected from the Army Medical Operational Data System Mainframe. Respondents of the survey were matched to MRC data. Comparisons were made using chi-square tests and Wilcoxon rank-sum non-parametric tests to determine whether there were differences in readiness and patient experience ratings before and after the encounter. Logistic regressions were also conducted to predict the odds of non-readiness based on the type of health care visit. RESULTS: Soldiers who were medically non-ready were more likely to be above age 35 years or have specialty care encounters. Results indicated those meeting all medical readiness requirements or having minor medical issues that could be resolved quickly, generally rated access to care slightly lower compared to those who were medically non-ready. Musculoskeletal Injuries (MSKIs) are the leading cause of medical non-readiness. As a result, this study explored access to care for MSKIs. Although there were no statistical differences in access ratings for those with MSKIs compared to those without MSKIs, there were statistically significant differences in self-reported health. Individuals with MSKIs tended to report poorer health status. Those with specialty care visits had 1.79 times significantly greater odds (p is less than .05) of being non-medically ready compared to those with primary care. For visits related to MSKI (e.g., physical medicine, orthopedic, or chiropractic etc.), those with an orthopedic or occupational therapy visit had 1.25 and 1.59 significantly greater odds (p is less than .05) of being considered not medically ready compared to all other MSKI related visits before the encounter. However, after the encounter, those with orthopedic care had significantly higher odds of improved readiness. CONCLUSIONS: Findings from this study help contextualize who is considered medically non-ready as well as differences in access to care experiences for this group. The lowest scoring areas for improving access to care include ease of making appointment, time between scheduling an appointment and the visit, and being seen past the scheduled time. Given that musculoskeletal injuries tend to require long term specialized treatments such as physical and occupational therapy, findings from the logistic regressions suggest that access and adherence to such treatments, particularly for orthopedic care, are helpful in improving medical readiness.

An Analysis of Patient Experience and Adherence to Diabetes Medication among Military Health System Beneficiaries.

OBJECTIVE: Few studies have investigated the relationship between patient experience and diabetes medication adherence among Military Health System (MHS) beneficiaries. We explored the link between patient experience survey ratings and adherence to diabetes medication. The hypothesis was that adherent patients would report better provider-patient experience than non-adherent patients. METHODS: Data included 2,599 patient surveys and pharmacy refill records. Adherence was determined using proportion of days covered (PDC) methodology where a patient must have had medications available 80% or more of the time during the observation period. Analysis involved multivariable logistic regression. RESULTS: Medication adherence was 60.2%. Regarding patient experience, those who were with their provider for 5 years or more had greater odds of adherence (OR 1.86[95%CI 1.19, 2.90]) Most of the patients in this study had high morbidity and high care utilization. Patient characteristics that significantly (p is less than 0.05) differentiated adherent versus non-adherent patients were race, mental health status, multiple medication use, glycated hemoglobin (HbA1c) levels, and health utilization. CONCLUSION: Two key factors of adherence that emerged from this study are that moderate (OR 2.54[95%CI 1.35, 4.75]) and elevated (OR 2.35[95%CI 1.29, 4.30]) HbA1c and patients with 7+ health care providers (OR 1.56[95%CI 1.06,2.29]) had greater odds of adherence. Findings suggest that ability to see provider when needed and provider continuity support adherence to treatment. The practice implications of this study are health practitioners can leverage patient experience and pharmacy data to identify patterns of adherence among patients in the MHS.

Military Health System Access to Care: Performance and Perceptions.

INTRODUCTION: Access to care (ATC) is an important component of providing quality healthcare. Clinics need to be able to accurately measure access; however, patients' reports of access may be different from performance-based data gathered using administrative measures. The purpose of this research is to examine the relationship between ATC administrative data and patient survey results. MATERIALS AND METHODS: This is a retrospective study performed in military medical treatment facilities. Survey data were obtained from the Joint Outpatient Experience Survey (JOES), and administrative data were collected from the Military Health System Data Repository. The data period was from May 2016 through March 2017 for 135 parent Military Treatment Facilities. This study was approved under the Defense Health Agency Internal Review Board (IRB number: CDO-15-2025). The analyses compare JOES ATC measures to administrative ATC measures. Overall correlation analyses and multivariate regression analyses were performed in order to generate observable correlations between access and healthcare measures (both administrative measures and patient survey items). RESULTS: Results show moderate correlations between the facilities' ATC survey items and administrative measures. These correlations were affected by the composition of the facility patient mix. The patient-based ATC measures from the JOES survey are related to administrative ATC measures collected and monitored by the facilities. In each final regression model, the coefficients for the ATC administrative variables were significant and negative which indicates that as the wait time for an appointment increases, patients' ratings of the time between scheduling and appointment dates declines and patients' assessments of being able to see a provider declines as well. CONCLUSIONS: Measuring ATC is a vital step in ensuring the health of patients and the provision of high quality care. Both patient surveys and administrative data are widely used for measuring ATC. This study found statistically significant moderate associations between survey and administrative ATC measures, which remained significant even after controlling for patient characteristics of the facilities. These study results suggest that administrative data can provide an accurate assessment of access; however, survey items can be useful for diagnosing potential issues with access, such as call center scheduling and provider availability. Future studies should explore the gaps in research surrounding best practices at facilities which have high patient experience with access, and look at other survey measures related to access, such as telephone resources and web-based communication programs.

A Preliminary Analysis of Noise Exposure and Medical Outcomes for Department of Defense Military Musicians.

Noise exposure is a known occupational health hazard to those serving in the military. Previous military epidemiology studies have identified military occupations at risk of noise induced hearing loss (NIHL); however, musicians have not been specifically mentioned. The focus of military NIHL studies is usually on those service members of the combat arms occupations. This project was a preliminary examination of Department of Defense (DoD) active duty military musicians in regard to their noise exposure, annual hearing test rates, and hearing injury rates using available data sources. The analysis concluded that DoD military musicians are an underserved population in terms of hearing conservation efforts. Noise surveillance data extracted from the Defense Occupational and Environmental Health Readiness System-Industrial Hygiene showed that every musician similar exposure group (SEG) with noise survey data from 2009 to 2013 exceeded the occupation exposure level adopted by DoD Instruction 6055.12. However, only a small percentage of all DoD active duty military musicians (5.5% in the peak year of 2012) were assigned to a SEG that was actually surveyed. Hearing test data based on Current Procedural Terminology coding extracted from the Military Health System revealed that the percentage of musicians with annual hearing tests increased over the 5 years studied in all services except the Air Force. During 2013, the data showed that the Navy had the highest percentage of musicians with annual hearing tests at 70.9%, and the Air Force had the lowest at 11.4%. The Air Force had the highest percentage of hearing injuries of those musicians with annual hearing tests for all 5 years analyzed. Although noise surveillance and annual hearing tests are being conducted, they occur at a much lower rate than required for a population that is known to be overexposed to noise.

Subjective measures of hearing aid benefit and satisfaction in the NIDCD/VA follow-up study.

Perceived benefit, satisfaction, and hearing aid use patterns were measured in a follow-up study to a large-scale multi-site clinical trial conducted in 1996-97. Measures included the Hearing Aid Status Questionnaire, the Profile of Hearing Aid Benefit, the Glasgow Hearing Aid Benefit Profile, the Satisfaction with Amplification in Daily Life, and the International Outcome Inventory for Hearing Aids. On the Profile of Hearing Aid Benefit, hearing aid users indicated more unaided difficulty in easy listening situations and less aided benefit in more difficult listening situations compared to the original study. Subjects who no longer used hearing aids indicated less difficulty in unaided situations. All measures indicated significant long-term subjective benefit and satisfaction with hearing aids. Although understanding speech in noise or in group situations continues to be problematic, subjects reported wearing their hearing aids almost all of the time in both easy and difficult listening situations.